Antepartum assessment - Fetus: Nursing

Antepartum fetal assessment refers to diagnostic procedures used to evaluate the fetal condition before birth.

Okay, let’s begin with assessment of fetal movement. Counting of fetal movements is a simple, cost-effective, and widely used method to monitor the well-being of a fetus. It’s based on the principle that if a fetus is compromised in some way, it will reduce its activity to conserve oxygen and energy. So, decreases in fetal movements or decreased activity in a previously active fetus might be due to a disturbance of placental function, and may precede an intrauterine fetal demise

Now, fetal movements start around the 7th to 8th week of gestation, and increase as gestation progresses. These movements can be felt by the client, typically starting around the 16th and 18th weeks of gestation. One of the most common methods is the “count to ten” method. The client is instructed to count fetal movements, including at the same time each day, ideally this will be a time when the client knows her fetus will be active, which is often during the evening hours. Although there is no well-established evidence of the number of fetal movements that are considered normal, generally, if less than 10 movements in a 2-3 hour period are felt, the client should contact her healthcare provider.  

Next up is ultrasound, which is a non-invasive test that uses high-frequency sound waves to visualize the fetus and monitor fetal growth; and can be done either transabdominally or transvaginally. Fetal growth can be assessed by measuring the biparietal diameter of the head and the fetal femur length, and birth weight can be estimated. Additionally, fetal anomalies such as open neural tube defects, including microcephaly or anencephaly, as well as ventral wall defects like omphalocele and gastroschisis can be detected. An ultrasound can also be used to measure nuchal translucency, which is a collection of fluid under the skin behind the fetal neck associated with trisomy 21. 

Another important assessment is the amniotic fluid volume. Too much amniotic fluid, called polyhydramnios or sometimes hydramnios, is associated with problems that impair fetal swallowing, such as esophageal atresia. On the other hand, too little amniotic fluid, called oligohydramnios, is associated with uteroplacental insufficiency or problems that impair fetal urine production, including renal agenesis or polycystic kidneys.